The Consequences of Alcohol Use Disorder in Women

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Alcohol use in the U.S. is common. People serve alcohol at parties, commemorative events, and at home. They include it as an option at occasions as diverse as backyard barbecues and executive business lunches. Adolescents experiment with alcohol, college students often make consuming alcohol a way of life, and adults use alcohol to relax, facilitate social interaction, and reward themselves after a hard day of work or play.

Its prevalence – while innocuous in many instances – can also lead to misuse. The 2017 National Survey on Drug Use and Health (2017 NSDUH) shows the following population-level data on alcohol use disorder (AUD) in the U.S.:

  • Adolescents: 443,000 – 1.8% of people age 12-17
  • Young Adults: 3.4 million – 10% of people age 18-25
  • Adults: 10.6 million – 5% of people age 26 +

Quick math tells us that almost 15 million people in the U.S. meet the clinical criteria for AUD, or what most people think of as alcoholism. Further examination of the numbers shows the rate of AUD gradually decreased for all age groups between 2002 and 2017. However, additional research reveals an increase in the prevalence of AUD in one group over the same time: women.

A study published by the American Psychological Association (APA) in 2014 explores the differences in the development and consequences of AUD in women, and how they differ for women and men. This article summarizes that study and discusses its implication for the treatment of AUD in women.

Prevalence of AUD in Women Compared to Men

In general, men experience higher rates of AUD than women. Here’s the data:

  • AUD in men: 24.6%
  • AUD in women: 11.5%

These numbers represent a distinct shift, not only over the past 15 years, as indicated above, but over the past 90 years. In the 1930s, data places the ratio of disordered alcohol use for men, compared to women, at seven to one (7:1). When we fast forward to 2017, we see that ratio close significantly: it now hovers around two to one (2:1). If you’re not used to reading or thinking in ratios, what this means is that about a hundred years ago, seven times more men than women experienced problem drinking. Now – or according to data from 2017 – only twice as many men than women experience problem drinking.

That’s a big change. The specific reasons behind the change are beyond the scope of this article, but it’s reasonable to suggest that the increased reporting of rates of AUD for women mirror their increased ability to participate in all aspects of society, from working, to owning property, to securing equal rights and access to a variety of social, political, and cultural activities that were previously denied them, as Supreme Court Justice Ruth Bader Ginsburg observed, “on the basis of sex.”

What is within the scope of this article, however, is identifying differences in the development and impact of AUD on women compared to men.

We’ll talk about those now.

AUD in Women: The Negative Effects

AUD causes severe, lasting, and negative impacts for anyone. Men, women, young people, old people – any person who develops disordered drinking patterns risks damage to their brain and body. The latest research tells us two important things: some of the negative impacts of AUD are more pronounced in women than in men, and AUD develops differently in women, as compared to men.

Research indicates the following short-term differences in the effect of alcohol consumption on women, compared to men. Women show:

  • Higher blood alcohol levels when consuming the same amount of alcohol
  • Increased cognitive impairment
  • Increased sedation (sleepiness)
  • Higher levels of impairment (drunkenness)
  • Increased levels of acute, alcohol-related injury
  • Increased risk of sexual assault (as victim)

Long-term differences in the effect of AUD on women, compared to men, include:

  • Increased risk of brain damage and shrinkage
  • Shorter time for brain damage and shrinkage to occur
  • Increased memory impairment
  • Increased cognitive impairment
  • Elevated risk of alcohol-related liver disease
  • Elevated risk of mouth, throat, esophageal, liver, breast and colon cancer
  • Greater risk of heart disease and cardiovascular complications
  • Increased risk of depression and mood disorders

Studies also show the negative impacts of alcohol consumption during pregnancy. Risks to newborns of mothers who consume alcohol excessively during pregnancy include:

  • Birth defects
  • Low birth weight
  • Fetal Alcohol Syndrome (FAS), which can cause:
    • Physical deformations
    • Slow growth (before and after birth
    • Defects in major organs
    • Defects in the brain and nervous system
    • Cognitive impairment
    • Social impairment
    • Memory impairment
    • Disrupted emotional development
    • Impaired balance

These elevated risks mean, in a nutshell, that AUD – or simply excessive drinking – has the chance to cause more damage, more quickly, to women than men. The authors of the APA study cited above put it this way:

“AUD appears to be a more severe form of psychopathology in women.”

From Knowledge to Action

There are two more pieces of information we left out – and both are relevant to our discussion. First, following initiation of alcohol use – i.e. their first drink – women develop patterns of disordered drinking more rapidly than men. Second, when women begin drinking during adolescence, the intensity and duration of AUD is greater than that found in men who begin drinking around the same time.

Taken together, all this information is critical for primary care physicians, physicians who specialize in women’s health, therapists, psychiatrists, and social workers involved with women’s issues. In other words, anyone directly involved in the health and wellbeing of women should understand the increased physical, emotional, and psychological risks associated with AUD in women compared to men.

Putting this knowledge into action means that medical and mental health professionals can include questions regarding alcohol consumption in any screenings they conduct during regular office visits. These professional caregivers can then act quickly on the information they collect. If women show signs of AUD, doctors and therapists can recommend treatment and support sooner rather than later – which can help women with disordered drinking patterns live healthy lives and significantly mitigate the negative short- and long-term consequences of AUD.